key: cord-1000431-bcpodj26
authors: Timóteo, Ana Teresa
title: Índice de Performance Miocárdica – será tempo de revisitar este parâmetro em doentes com COVID-19?
date: 2022-02-18
journal: Rev Port Cardiol
DOI: 10.1016/j.repc.2022.02.005
sha: 411e09629a2f1ce19d1c0eae5ce8ef2d53f4bd9e
doc_id: 1000431
cord_uid: bcpodj26

nan

Índice de Performance Miocárdicaserá tempo de revisitar este parâmetro em doentes com COVID-19?

In 2020, coronavirus disease 19 (COVID-19) emerged as a severe pandemic disease and a public health crisis that imposed significant pressure on healthcare services across the world. Respiratory manifestations are the most frequent and severe. However, cardiac manifestations have also been described. Early reports showed that in patients with confirmed COVID-19 in the hospital setting, 55%

had an abnormal echocardiogram, in similar proportions (around 35%) in the right and left heart, with severe findings in 15%. 1 Despite this significant number, new myocardial infarction, myocarditis and takotsubo cardiomyopathy were each only identified in around 3% of patients. 1 Cardiac troponin and the severity of COVID-19 symptoms were independent predictors of right and left ventricular abnormalities. 1 Echocardiography has the advantage of being widely accessible and portable and can be performed at the patient's bedside in the intensive care unit or emergency room in critically ill patients or in ward rooms for less critical patients, always with personal protective equipment. In COVID-19 patients, a focused cardiac ultrasound study was recommended to reduce the time of exposure with the patient and to reduce the risk of contamination, preferably with hand-held or smaller laptop-based scanners. 2 The myocardial performance index (MPI) was described by Tei almost two decades ago, in 1995, and includes both systolic and diastolic time intervals to assess global cardiac function. 3 Conventional Doppler-derived parameters were used initially, but measurements of time intervals are based on flowvelocity curves that are performed in different cardiac cycles and this can be a limitation. At that time, they demonstrated prognostic value in several heart conditions. MPI calculations can now be performed with pulsed-wave tissue Doppler imaging, allowing for simultaneous measurements of both diastolic and systolic intervals in the same cardiac cycle. However, recent studies have challenged this method, because it showed poor clinical agreement and was not a reliable parameter for the assessment of left ventricular function. 4 Nonetheless, MPI is very easy to obtain and record, is reproducible, and also has the advantage of being independent of arterial pressure, heart rate, afterload and preload. For this reason, its use in the context of COVID-19 infection is appropriate, because it can be obtained with a brief acquisition time in a fast acquisition protocol at the patient's bedside.

In the current issue of the Journal, Kaya 

Global evaluation of echocardiography in patients with COVID-19

COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel

New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function -a study in normal and dilated cardiomyopathy

Clinical value of myocardial performance index in patients with isolated diastolic dysfunction

Assessment of Myocardial Performance Index in Patients with COVID-19: An Echocardiographic Follow-up Study

Subclinical left ventricular dysfunction in COVID-19

Subclinical myocardial dysfunction in patients recovered from COVId-19